More Fat Talk

*I wanted to highlight the last comment from Pamela because it says so much of what I was thinking in class... I wish I had had the clinical experience to say some of what is said here...

My favorite accusation is the one that blames overweight women for the increase in maternal morbidity.

I tell you what, gestational diabetes is a joke as it is presented. the only "GD" I accept is women on the verge of type II diabetes before pregnancy and then, with natural decreased pancreas function in pregnancy, have blood sugar issues. Can we just get rid of the GTT? please? and why so many varying, and conflicting, lab values for "diagnoses"?

In my practice, the worst hypertensive and hyperglycemic cases have been from thin women. Especially blood sugar issues - usually related to women older than 40 who have poor diets.

I can't even get over how few providers know about using a larger cuff to measure BP on heavier women.

I just get sick of the "fat=big baby/hypertension/diabetes/cesarean section"

More and more plus-sized women are being set up for cesarean sections right from the start of care based on these biases. And guess what? Plus-sized women do not heal well from cesareans. So maybe the increase in complications with these women are based purely on fatphobia.

In my medical records, 14 years ago, I was labeled "obese" because I weighed 165 pounds at the start of my pregnancy.

I contacted a midwife in the city I'm moving too ask about their risk-out criteria for homebirth with their practice. I told her that I am obese, and still want a homebirth. She told me that they didn't automatically risk out for that, and explained that they'd have to decide after meeting me and seeing my personal habitus. She said their primary concern is not being able to do good fundal massage in the case of hemorrhage. I had never thought about this, but now of course I think about it often. lol. Every classroom session for me now is fear inducing. I always leave class thinking "should I really be trying to get pregnant?" I have so many damn risk factors that it has taken the joy and positivity out of even the idea of being pregnant. The worse days are the maternal mortality days. I have to spend ALL DAY reminding myself that birth is a natural process and that, yes, there can be complications, but there can also be low risk intervention free homebirth for fat women that doesn't end in death. Seriously I have to go through all that... not only for myself, but for the women I will see this week and the next and those in the following year who deserve not only evidenced based information, but also the right to hope and happiness. So much of how we process and experience birth is mental... how sad would it be to instill fear in a woman when she needs it least.

And thus we return to the balancing act... telling her risks without sounding all doom and gloom. Being realistic about what she can change and what she most likely cant or wont. Hmmm. What I can change (and already have) is what I eat and how much exercise I get... I can take a multi or prenatal vitamin everyday... I can refrain from large doses of alcohol and coffee... what I can't change is the risk factors I have associated with race, ethnicity, and genetics...

Navelgazing also writes a lot about fat.

I wrote about it a few times over the course of my education, but I think I've lost all patience and have so little energy to repeat myself in the classroom!